Trauma
Retrobulbar Hematoma
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Retrobulbar Hematoma
, Retrobulbar Hemorrhage, Acute Orbital Compartment Syndrome
See Also
Lateral Canthotomy
Pathophysiology
Trauma
to eye results in infraorbital artery distribution
Hemorrhage
Orbit is a closed space
Surrounded by bone in all planes except anteriorly
Anterior margin is blocked by the medial and lateral canthal tendons which hold the globe in the orbit
Hemorrhage
results in increased orbital pressures
Compartment Syndrome
results if these pressures are not decompressed
Compression of artery and
Optic Nerve
Retina
l ischemia results when
Intraocular Pressure
increases above central
Retina
l artery pressure
Irreversible injury may start within 60 minutes of ischemia onset
Signs
Eye Pain
Decreased Visual Acuity
Proptosis
Subconjunctival Hemorrhage
Decreased
Extraocular Movement
Afferent pupil defect
Associated with
Optic Nerve
injury
Imaging
CT Head
Bedside
Orbital Ultrasound
Exercise
caution to prevent significant pressure on globe
Management
Gene
ral
Emergent opthalmology
Consultation
for surgical decompression
Emergent
Lateral Canthotomy
(see below) if indicated
Management
Lateral Canthotomy
Indications
Retrobulbar Hematoma and
Primary indications
Proptosis
Intraocular Pressure
>40 mmHg
Decreased Visual Acuity
Secondary indications
Afferent Pupillary Defect
(see
Orbital Ultrasound
)
Eye Pain
Funduscopic changes
Cherry red
Macula
Pallor of the nerve head
References
Dreis (2020) Crit Dec Emerg Med 34(7):3-21
Peak in O'Connor (2012) Medscape: EMedicine
http://emedicine.medscape.com/article/799528-overview#showall
Wu in Majoewsky (2012) EM:Rap 12(11):11-12
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